Comment Corner: Finding That Sweet Spot for Movement -- Not Too Much, Not Too Little

Letters, we get letters (well, comments):

I'm 44, weigh 119 lbs, and hurt my knees running marathons 6 yrs ago. Thank you so much for helping the rest of us! You've mentioned "pushing the envelope" and I'd like to know how to plan my recovery. Do you suggest increasing the # of steps by a certain amt/% each week? I feel lost in knowing what to do - I would like a plan. I wear a pedometer and it's showing my daily steps are around 10,000. That seems like a lot compared to what you've mentioned. I don't feel any better (I'm in discomfort all day) but also not worse - you've said that is ok, right? Or should I do less steps until I feel better and then increase my steps? How does one know how to "push the envelope" without causing further harm? Thanks!!! Theresa

This is a great comment because these are some of the best (and hardest) questions. I wish I could pluck simple, satisfying answers from the air (6,400, at least nine weeks but no more than 12, when it turns red but is not inflamed). Unfortunately, there is no magic formula.

(Usual disclaimer by the way: I'm not a doctor or trained medical professional, so naturally discuss the following with one).

Do you suggest increasing the # of steps by a certain amt/% each week?

No. In my opinion, that would be crazy.

That would be crazy because all knees are different and, what's more, a strict rule (or even a rule of thumb) doesn't allow for inevitable setbacks. You may be happily increasing your step count by 15 percent every four weeks, then boom! You go on an ill-advised hike, suffer a setback, and all of a sudden you're struggling just to maintain your normal daily program.

However, I would consider (a) starting a knee journal, to help figure out when it's appropriate to increase step counts (b) getting on a once-a-week planning schedule. I used to do a weekly entry in my knee journal where I jotted down my observations about what went right (and wrong) that week and laid out my plan (including step counts) for the upcoming 7 days.

I don't feel any better (I'm in discomfort all day) but also not worse - you've said that is ok, right?

It seems that may be okay. But that may not be okay. It depends.

If you've been doing 10,000 steps daily for a year, and you feel about the same, I'd tend to say, "That's not okay." You're not getting better.

If you've been doing 10,000 steps daily for a few weeks, with no improvement, but before that you were feeling worse each week, I'd tend to say, "That's probably okay." Hopefully, you're in a transition period to getting better.

Or should I do less steps until I feel better and then increase my steps?

It's hard to say, but I do believe that with healing bad knees, you have to err on the conservative side. I went really, really conservative at one point (just doing simple walkarounds at the pool) and was surprised how effective that was.

If, by nature, you're competitive, motivated and driven (as I was, and I suspect you are), I would modify that comment a little to: ERR ON THE CONSERVATIVE SIDE. That's because you're especially at risk of pushing too hard because of who you are.

How does one know how to "push the envelope" without causing further harm?

First, I think you have to think more in terms of "nudging" the envelope, if you will. Still, this is the hard crux of the matter. It returns us to that central puzzle: How many steps should you be taking, and how do you know when (and by how much) to increase them?

Here are my two best ideas:

Try to work with a smart physical therapist, who (hopefully) can measure the strength of your bad knee and help you design a program around what it's capable of doing. Someday, I predict, most physical therapists will do these measurements as a matter of course. Today, sadly, we're still in the semi-Dark Ages on chronic knee pain and how best to treat it.

However, Sports Center in Austin does this sort of "load" testing. If you can go there, I would.

Experiment. I spent a lot of time doing this. Experimenting does require a good ability to sniff out immediately when something isn't working and when it deserves to be given a few weeks or so before being abandoned.

Is 10,000 daily steps too much? Try 5,000 or 6,000 or 7,000 for a few weeks. Or try taking steps in smaller bunches. Or trying taking different kinds of steps. Or ...

The possibilities are constrained only by your imagination. Whatever you do though, document it carefully and smartly so you're constantly learning what works and what doesn't. Pretend you're a scientist. That's what I did, basically.

Yeah, no easy answers. Yeah, a lot of work (and patience) required. But if it was easy, no one would have bad knees, would they? :)